Provider Demographics
NPI:1124078142
Name:KAVATHIA, SANJAY (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:
Last Name:KAVATHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 WILLOW GROVE ST
Mailing Address - Street 2:UNIT 1A
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1779
Mailing Address - Country:US
Mailing Address - Phone:908-852-8484
Mailing Address - Fax:908-852-4197
Practice Address - Street 1:616 WILLOW GROVE ST
Practice Address - Street 2:UNIT 1A
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1779
Practice Address - Country:US
Practice Address - Phone:908-852-8484
Practice Address - Fax:908-852-4197
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA072670207R00000X
NJ25MA07267000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0228763OtherUNITED HEALTHCARE
NJ8684308Medicaid
NJP2530863OtherOXFORD
NJ2619378OtherAETNA PPO
NJAMERIGROUPOtherGP10
NJDC6255OtherRAILROAD MEDICARE
NJ000133641OtherAETNA HMO
NJ8684308Medicaid
NJ086789Medicare ID - Type UnspecifiedGROUP ID
NJ2619378OtherAETNA PPO